A client who is taking methylprednisolone reports feeling thirsty. Which action should the nurse take first?

Potential Conditions

Anemia: Anemia commonly causes fatigue and weakness, but it does not typically explain diarrhea. Additionally, the use of spironolactone, a potassium-sparing diuretic, makes electrolyte imbalance a more likely cause of these symptoms rather than anemia.

Hepatic failure: While hepatic failure could cause fatigue and systemic symptoms, it usually presents with jaundice, ascites, or confusion in advanced cases. There are no signs of liver-related symptoms in this scenario, making hepatic failure less likely.

Hyperkalemia: Hyperkalemia is the most likely condition because spironolactone can cause potassium retention. Symptoms such as fatigue, muscle weakness, and gastrointestinal disturbances like diarrhea are classic early signs of elevated potassium levels.

Hyperuricemia: Hyperuricemia is characterized by elevated uric acid levels, often leading to gout attacks rather than gastrointestinal symptoms or muscle weakness. Therefore, it is not the primary concern with this client’s current presentation.

Actions to take

Check the client's oxygen saturation: Although oxygen saturation is important in many acute settings, the client’s symptoms suggest a metabolic issue rather than a respiratory problem. Checking oxygenation would not directly address suspected hyperkalemia.

Do a point of care glucose check: Checking glucose is appropriate for clients with symptoms of hyperglycemia or hypoglycemia, but this client’s symptoms and medication history point more toward an electrolyte imbalance rather than a glucose-related disorder.

Measure the client's abdominal girth: Measuring abdominal girth is useful for detecting fluid accumulation, such as ascites in liver failure, but it is not relevant in the assessment of hyperkalemia. It would not provide information needed for the client’s immediate concern.

Ask the client about their diet: Dietary habits, particularly potassium intake, can significantly impact potassium levels when using potassium-sparing medications like spironolactone. Understanding the client's diet can help identify factors contributing to hyperkalemia.

Do a blood chemistry panel: A blood chemistry panel would provide critical information about serum electrolytes, including potassium levels. It is essential for diagnosing and confirming hyperkalemia and guiding further treatment decisions.

Parameters to Monitor

Edema: While edema monitoring is important in some chronic conditions like heart failure, it is not a primary concern with hyperkalemia. Hyperkalemia affects muscle and cardiac conduction, not typically fluid balance or peripheral swelling.

Skin color: Monitoring skin color can reveal perfusion issues but does not directly help detect or manage hyperkalemia. Changes in skin color would not provide early or specific warning signs of worsening potassium levels.

Pedal pulses: Pedal pulses are useful in assessing circulatory problems such as peripheral arterial disease but are not directly related to the cardiac conduction disturbances seen in hyperkalemia. Focus should instead be on heart rhythm.

Potassium level: Potassium level monitoring is essential because hyperkalemia can progress quickly and lead to life-threatening cardiac complications. Keeping track of potassium levels helps assess the severity of the imbalance and the response to treatment.

Heart Rhythm: Monitoring heart rhythm is critical, as hyperkalemia can cause bradycardia, peaked T waves, and even cardiac arrest. Continuous cardiac monitoring allows for early detection of dangerous arrhythmias resulting from elevated potassium.

A. Assess the client's vital signs: While it is always important to monitor vital signs, the increase in white blood cell (WBC) count indicates a positive response to filgrastim, and there is no immediate concern requiring urgent vital sign assessment based on the WBC count alone.

B. Review the client's culture and sensitivity reports: Reviewing culture reports is necessary when managing an active infection, but the question does not indicate the client currently has an infection. The focus here is evaluating the medication's effectiveness.

C. Implement neutropenic precautions: Neutropenic precautions are necessary when the WBC count is critically low. Since the client's WBC has improved into the low-normal range, these precautions are no longer necessary.

D. Inform the client that the medication has been effective: Filgrastim is used to stimulate WBC production. The client's WBC count has increased to the normal range after five doses, demonstrating that the medication is working effectively as intended.